Show simple item record

dc.contributor.authorCarin-Levy, Gail
dc.contributor.authorMead, Gillian
dc.contributor.authorNicol, Kath
dc.contributor.authorRush, Robert
dc.contributor.authorvan Wijck, Frederike
dc.date.accessioned2018-06-29T21:42:01Z
dc.date.available2018-06-29T21:42:01Z
dc.date.issued2012-08
dc.identifierER2615
dc.identifier.citationCarin-Levy, G., Mead, G., Nicol, K., Rush, R. & van Wijck, F. (2012-08) Delirium in acute stroke: screening tools, incidence rates and predictors: a systematic review., Journal of Neurology, vol. 259, pp. 1590-1599.
dc.identifier.issn0340-5354
dc.identifier.urihttp://dx.doi.org/10.1007/s00415-011-6383-4
dc.identifier.urihttps://eresearch.qmu.ac.uk/handle/20.500.12289/2615
dc.description.abstractDelirium is a common complication in acute stroke yet there is uncertainty regarding how best to screen for and diagnose delirium after stroke. We sought to establish how delirium after stroke is identified, its incidence rates and factors predicting its development. We conducted a systematic review of studies investigating delirium in acute stroke. We searched The Cochrane Collaboration, MEDLINE, EMBASE, CINHAL, PsychINFO, Web of Science, British Nursing Index, PEDro and OT Seeker in October 2010. A total of 3,127 citations were screened, full text of 60 titles and abstracts were read, of which 20 studies published between 1984 and 2010 were included in this review. The methods most commonly used to identify delirium were generic assessment tools such as the Delirium Rating Scale (n = 5) or the Confusion Assessment Method (n = 2) or both (n = 2). The incidence of delirium in acute stroke ranged from 2.3-66%, with our meta-analysis random effects approach placing the rate at 26% (95% CI 19-33%). Of the 11 studies reporting risk factors for delirium, increased age, aphasia, neglect or dysphagia, visual disturbance and elevated cortisol levels were associated with the development of delirium in at least one study. The outcomes associated with the condition are increased morbidity and mortality. Delirium is found in around 26% of stroke patients. Difference in diagnostic and screening procedures could explain the wide variation in frequency of delirium. There are a number of factors that may predict the development of the condition.
dc.format.extent1590-1599
dc.publisherspringer verlag
dc.relation.ispartofJournal of Neurology
dc.subjectDelirium
dc.subjectAcute Stroke
dc.subjectDiagnosis And Screening
dc.titleDelirium in acute stroke: screening tools, incidence rates and predictors: a systematic review.
dc.typearticle
dcterms.accessRightsrestricted
dc.description.facultysch_occ
dc.description.referencetext(1) Inouye SK, Bogardus ST, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, Cooney LMJ. (1999) A multicomponent intervention to prevent delirium in hospitalized older patients. New England Journal of Medicine 340:669-76. (2) Henon H, Lebert F, Durieu I, Godefroy O, Lucas C, Pasquier F, Leys D. (1999) Confusional state in stroke: relation to preexisting dementia, patient characteristics, and outcome. Stroke; A Journal Of Cerebral Circulation 30:773-9. (3) Siddiqi N, House AO, Holmes JD. (2006) Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age And Ageing 35:350-64. (4) McCusker J, Cole MG, Dendukuri N, Belzile E. (2003) Does delirium increase hospital stay? Journal of the American Geriatrics Society 51:1539-46. (5) Young J, Inouye SK. (2007) Delirium in older people. BMJ (Clinical Research Ed ) 334:842-6. (6) Carson A, Zeman A, Brown T, Sharpe M. (2004) Organic Disorders. In: Johnstone E, Cunningham Owens D, Lawrie S, Sharpe M, Freeman C, editors. Companion to Psychiatric Studies. 7 ed. Edinburgh: Churchill Livingstone; p. 341-4. (7) Scottish Intercollegiate Guidelines Network. (2010) Management of Patients with Stroke: Rehabilitation, prevention and management of complications, and discharge planning. A National Clinical Guideline. NHS Quality Improvement Scotland. (8) National Institute for Health and Clinical Excellence. (2008) Stroke: National Clinical Guidelines for Treatment amd Initial Management of Acute Stroke and Transient Ischaemic Attack (TIA). London, Royal College of Physicians. (9) National Institute for Clinical Excellence. (2010) Delirium: Diagnosis Prevention and Management. NICE. (10) McManus J, Pathansali R, Stewart R, Macdonald A, Jackson S. (2007) Delirium post-stroke. Age & Ageing 36:613-8. (11) Downs SH, Black N. (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Journal Of Epidemiology And Community Health 52:377-84. (12) Hatano S. (1976) Experience from a Multicentre Stroke Register: a Preliminary Report. Bulletin of the World Health Organisation;54 Available at: URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2366492/. AccessedSeptember 15, 2010. (13) Whiting P, Rutjes AWS, Reitsma JB, Bossuyt PMM, Kleijnen J. (2003) The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Medical Research Methodology 3:25. (14) Deeks J. (2001) Systematic reviews of evaluations of diagnostic and screening tests. In: Egger M, Davey Smith G, Altman D, editors. Systematic Reviews in Health Care: Meta-Analysis in Context.London: BMJ Publishing Group; p. 248-82. (15) American Psychiatric Association. (1980) Diagnostic and Statistical Manual of Mental Disorders DSM III. 3rd ed. Washington DC: American Psychiatric Association. (16) American Psychiatric Association. (1987) Diagnostic and Statistical Manual of Mental Disorders: DSM-III-R. Washington DC: American Psychiatric Association. (17) American Psychiatric Association. (1994) Diagnostic and Statistical Manual of Mental Disorders: DSM IV. Washington DC: American Psychiatric Association. (18) American Psychiatric Association. (2002) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-R). 4th Edition ed. Washington DC: American Psychiatric Association Press. (19) Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. (1990) Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Annals Of Internal Medicine 13:941-8. (20) Trzepacz PT, Baker RW, Greenhouse J. (1988) A symptom rating scale for delirium. Psychiatry Research 23:89- 97. (21) Gustafson L, Lindgren M, Westling B. (1995) The OBS Scale - a factor analysis approach to evaluation of confusional states and other Organic Brain Syndromes. Unpublished Work available from: http://www.med.lu.se. Accessed: 1-6-2011 (22) Folstein MF, Folstein SE, McHugh PR. (1975) Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12:189-98. (23) Caeiro L, Ferro JM, Albuquerque R, Figueira ML. (2004) Delirium in the first days of acute stroke. Journal Of Neurology 251:171-8. (24) Dostovic Z, Smajlovic D, Sinanovic O, Vidovic M. (2009) Duration of Delirium in the Acute Stage of Stroke. Acta Clinica Croatica 48:13-7. (25) Sandberg O, Franklin KA, Bucht G, Gustafson Y. (2001) Sleep Apnea, Delirium, Depressed Mood, Cognition, and ADL Ability After Stroke. Journal of the American Geriatrics Society 49:391-7. (26) Sheng AZ, Shen Q, Cordato D, Zhang YY, Yin Chan DK. (2006) Delirium within three days of stroke in a cohort of elderly patients. Journal of the American Geriatrics Society 54:1192-8. (27) Dahl MH, Ronning OM, Thommessen B. (2010) Delirium in acute stroke - Prevalence and risk factors. Acta Neurologica Scandinavica 122(SUPPL. 190):39-43. (28) Fassbender K, Schmidt R, Mossner R, Daffertshofer M, Hennerici M. (1994) Pattern of activation of the hypothalamic-pituitary-adrenal axis in acute stroke. Relation to acute confusional state, extent of brain damage, and clinical outcome. Stroke; A Journal Of Cerebral Circulation 25:1105-8. (29) Gustafson Y, Olsson T, Asplund K, Hagg E. (1993) Acute Confusional State (Delirium) Soon After Stroke Is Associated with Hypercortisolism. Cerebrovascular Diseases 3:33-8. (30) Gustafson Y, Olsson T, Eriksson S, Asplund K, Bucht G. (1991) Acute Confusional States (Delirium) in Stroke Patients. Cerebrovascular Diseases 1:257-64. (31) Caeiro L, Ferro M, Claro MI, Coelho J, Albuquerque R, Figueira ML. (2004) Delirium in acute stroke: a preliminary study of the role of anticholinergic medications. European Journal of Neurology 11:699-704. (32) Caeiro L, Menger C, Ferro JM, Albuquerque R, Figueira ML. (2005) Delirium in acute subarachnoid haemorrhage. Cerebrovascular Diseases 19:31-8. (33) Dunne JW, Leedman PJ, Edis RH. (1986) Inobvious stroke: a cause of delirium and dementia. Australian And New Zealand Journal Of Medicine 16:771-8. (34) Shih HT, Huang WS, Liu CH, Tsai TC, Lu CT, Lu MK, Chen PK, Tseng CH, Jou SB, Tsai CH, Lee CC. (2007) Confusion or delirium in patients with posterior cerebral arterial infarction. Acta Neurologica Taiwanica 16:136- 42. (35) Nicolai A, Lazzarino LG. (1994) Acute confusional states secondary to infarctions in the territory of the posterior cerebral artery in elderly patients. Italian Journal of Neurological Sciences 15:91-6. (36) Mori E, Yamadori A. (1987) Acute confusional state and acute agitated delirium: Occurrence after infarction in the right middle cerebral artery territory. Archives of Neurology 44:1139-43. (37) Marklund N, Peltonen M, Nilsson TK, Olsson T. (2004) Low and high circulating cortisol levels predict mortality and cognitive dysfunction early after stroke. Journal of Internal Medicine 256:15-21. (38) McManus J, Pathansali R, Hassan H, Ouldred E, Cooper D, Stewart R, Macdonald A, Jackson S. (2009) The course of delirium in acute stroke. Age And Ageing 38:385-9. (39) McManus J, Pathansali R, Hassan H, Ouldred E, Cooper D, Stewart R, Macdonald A, Jackson S. (2009) The evaluation of delirium post-stroke. International Journal of Geriatric Psychiatry 24:1251-6. (40) Oldenbeuving AW, de Kort PLM, Jansen BPW, Kappelle LJ, Roks G. (2008) A pilot study of rivastigmine in the treatment of delirium after stroke: a safe alternative. BMC Neurology 8:34. (41) Bjorkelund KB, Larsson S, Gustafson L, Andersson E. (2006) The Organic Brain Syndrome (OBS) Scale: a systematic review. International Journal of Geriatric Psychiatry 21:210-22. (42) Sandberg O, Gustafson Y, Brannstrom B, Bucht G. (1999) Clinical Profile of Delirium in Older Patients. Journal of American Geriatric Society 47:1300-6. (43) Egger M, Davey Smith G, Schneider M. (2001) Systematic Reviews of Observational Studies. In: Egger M, Davey Smith G, Altman D, editors. Systematic Reviews in Health Care Meta Analysis in Context. 2nd ed. London: BMJ Publishing Group; p. 211-27. (44) Schmidley JW, Messing RO. (1984) Agitated confusional states in patients with right hemisphere infarctions. Stroke 15:883-5. (45) Oldenbeuving AW, de Kort PLM, Jansen BPW, Roks G, Kappelle LJ. (2007) Delirium in acute stroke: a review. International Journal of Stroke 2:270-5. (46) White S, Bayer A. (2007) Delirium: a clinical overview. Reviews in Clinical Gerontology 17:45-62. (47) Jensen E, Dehlin O, Gustafson L. (1993) A comparison between three psychogeriatric rating scales. International Journal of Geriatric Psychiatry 8:215-29. (48) Scottish Intercollegiate Guidelines Network. (2002) SIGN 64: Management of Patients with Stroke. Rehabilitation, prevention and management of complications, and discharge planning. A national clinical guideline. 1-51. Edinburgh, SIGN. (49) Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R. (2001) Delirium in mechanically ventilated patients: Validity and reliability of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). JAMA 286:2703-10. (50) Oldenbeuving AW, de Kort PLM, Jansen BPW, Algra A, Kappelle LJ, Roks G. (2011) Delirium in the acute phase after stroke: Incidence, risk factors, and outcome. Neurology 76:993-9. (51) Tune LE, Egeli S. (1999) Acetylcholine and Delirium. Dementia And Geriatric Cognitive Disorders 10:342-4. (52) Caplan LR. (2010) Delirium: a neurologist's view - the neurology of agitation and overactivity. Reviews in Neurological Disease 7:111-8. (53) Burns A, Galllagley A, Byrne J. (2004) Delirium. Journal of Neurology Neurosurgery and Psychiatry 75:362-7.
dc.description.volume259
dc.description.ispublishedpub
dc.description.eprintid2615
rioxxterms.typearticle
qmu.authorvan Wijck, Frederike
qmu.authorCarin-Levy, Gail
qmu.authorNicol, Kath
qmu.authorRush, Robert
dc.description.statuspub
dc.description.number8


Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record